tbuckley/cabot-search huggingface dataset:
Abstract 08: Computed Tomography Perfusion Of Cerebral Blood Flow During Open Cardiac Massage For Hypovolemic And Normovolemic Cardiac Arrest In Swine
Authors: Rebecca N Treffalls, David P Stonko, Neerav Patel, Joseph Edwards, Hossam Abdou, Noha Elansary, Patrick Walker, Jonathan J Morrison
Journal: Circulation (2022)

Introduction: Adequate cerebral blood flow (CBF) during open cardiac massage (OCM) in cardiac arrest is critical for survivors to be neurologically intact. Cerebral perfusion is known to be poor during OCM but has not been quantified using a brain perfusion technique. The aim of this study is to measure CBF in swine undergoing OCM in hypovolemia and normovolemia using computed tomography perfusion (CTP) scanning. Methods: Anesthetized swine underwent instrumentation with right atrial and aortic pressure catheters. A pigtail catheter placed in the ascending aorta was used to administer iodinated contrast and CTP imaging acquired. Brain parenchymal attenuation was measured over time from which CBF (mL/100g of brain) and time to peak (TTP; secs) were derived. Animals were then euthanized exsanguination (hypovolemic group) or potassium chloride injection (normovolemic group). Animals were subject to a clamshell thoracotomy, OCM and repeated CTP. Data pertaining to peak coronary perfusion pressure (pCPP; mmHg) was collected and % CPP &gt;15mmHg (% CPP; secs) calculated post hoc. Results: Normovolemic animals achieved superior pCPP compared to the hypovolemic animals (pCPP: 39.3 vs 12.3, p&lt;0.001; % CPP: 14.5 ± 1.9 vs 30.9 ± 6.5, p&lt;0.001). CTP was successfully performed during OCM generating an attenuation curve (figure). The TTP elongated from spontaneous circulation, normovolemia to hypovolemia (5.7 vs 10.8 vs 14.8, p=0.01). CBF during OCM was similar between hypovolemic and normovolemic groups (7.5 ± 8.1 vs 4.9 ± 6.0, p =0.73) which was lower than baseline values (51.9 ± 12.1, p&lt;0.001). Conclusions: OCM in normovolemia generates superior coronary hemodynamics compared to hypovolemia. Despite this, neither generates adequate CBF as measured by CTP, compared to baseline. To improve the rate of neurologically intact survivors, novel resuscitative techniques need to be investigated that specifically target cerebral perfusion as existing techniques are inadequate.
Abstract 10679: Do Hospitals Caring for a High Proportion of Black Adults Deliver Lower Quality Care for Heart Failure? An Analysis of the Get With the Guidelines-Heart Failure Registry
Authors: Jamie E Diamond, Iyanuoluwa Ayodele, Karen E Joynt Maddox, Robert W Yeh, Gregg C Fonarow, Larry A Allen, Stephen J Greene, Adam D Devore, Karen Chiswell, Clyde W Yancy, Rishi Wadhera
Journal: Circulation (2022)

Introduction: Black individuals have higher hospitalization and mortality rates from heart failure (HF). Black adults receive care at a limited set of US hospitals (minority-serving hospitals [MSH]) and understanding quality of care at these sites could inform efforts to improve health equity. Using the Get With The Guidelines (GWTG) - HF Registry, we compared HF care quality and clinical outcomes at MSH vs. non-MSH. Methods: We identified adults ≥18 years hospitalized for HF at GWTG-HF sites. MSH were defined as the top quintile of proportion of hospitalizations for Black adults. We compared performance on GWTG-HF quality measures at MSH vs. non-MSH, adjusting for age, sex, comorbidities, and hospital characteristics, using GEE to account for clustering within sites. After restricting to adults ≥65 years and linking to Medicare FFS claims, we used multivariable Cox proportional hazard models to compare post-discharge outcomes. Results: Study population included 422,483 hospitalizations at 480 hospitals, of which 96 (with &gt;38% Black patients) were MSH. Care quality was similar between MSHs and non-MSHs for 10 of 13 GWTG-HF measures; MSH patients were less likely to be discharged with 7-day follow up, CRT device planning, or aldosterone antagonist (Figure). Overall defect-free care was similar across sites; there were no within-hospital disparities between Black vs. White patients at both MSH and non-MSH. Among 111,930 Medicare beneficiaries, risk-adjusted 30-day readmissions were higher at MSH compared with non-MSH (HR 1.14, 95% CI 1.02-1.26), but risk-adjusted 30-day mortality was similar (HR 0.92, 95% CI 0.84-1.02). Conclusions: Across GWTG-HF-participating hospitals, HF care quality and mortality were similar at MSH vs. non-MSH, but MSH 30-day readmissions were higher. Improving MSH post-discharge follow-up could improve equity in HF outcomes, though additional investigation to address higher MSH readmissions is needed.
Abstract 10087: Cognitive Evaluation During Pregnancy Among Women With Preeclampsia: A Pilot Feasibility Study
Authors: Andrea Ibarra, Grace Lim, Meryl Butters, Janet M Catov
Journal: Circulation (2022)

Introduction: Previous research has shown cognitive decline related to preeclampsia (preE) in women after pregnancy when using neurocognitive assessments; however, it is not known if changes in cognition occur antenatally (e.g., in the third trimester of pregnancy). This pilot study investigated if the cerebrovascular effect of preE can manifest as cognitive decline antenatally. Hypothesis: Pregnant preE women will score lower on cognitive tests in the executive and memory function domains compared with pregnant normotensive women. Methods: This was a prospective observational study in a single institution. We included women more than 28 weeks of gestation with preE or normotension. We excluded women with chronic hypertension, neurologic and developmental disabilities, and current substance use. Neurocognitive test battery included subjective (Everyday Cognition) and objective assessment of executive function (Stroop test, Trail Making), attention and working memory (Digit Span Subtest), and information processing speed (Digit Symbol Substitution) evaluated as z-scores. Baseline characteristics (e.g. pre-pregnancy Body mass index [BMI]) characteristics were collected. Results: We enrolled 1 to 2 women weekly over 4 months. Thirty pregnant women were included (16 preE; 14 normotensive). Those with preE had higher pre-pregnancy BMI, delivered at earlier gestational age and reported higher history of migraines. PreE vs. normotensive women had more memory complaints (p&lt;0.001) and scored lower on objective measures of information processing speed, attention, and the executive function of inhibition ( Table ). Conclusions: Assessment of cognition in pregnant preE and normotensive women is feasible. PreE women reported worse subjective memory, and had lower scores in attention, information processing speed, and the executive function. Future work to determine if these cognitive differences persist postpartum is warranted.
Abstract 10745: Return to Play After Covid-19 Infection: Cardiac Imaging Findings in Youth
Authors: Suellen M Yin, jennifer bachman, Audrey Dionne, Kevin G Friedman, Jane W Newburger, Naomi Gauthier, Keri M Shafer, Daniel A Castellanos, Annette L Baker, Sarah Atwood, Patricia Burke, Mark E Alexander, Sarah D De Ferranti
Journal: Circulation (2022)

Introduction: SARS CoV2 has been associated with acute and subacute myocarditis. Screening after COVID-19 has been recommended prior to returning to physical activity. The yield of such investigations, particularly in youth, remains unknown. Methods: Retrospective chart review was performed of patients evaluated in a cardiology clinic for return to play (RTP) after COVID-19 between 01/20 - 06/21. Iteratively updated guidance for testing was provided to ambulatory providers. Patients with MIS-C were excluded. We reviewed demographics, clinical evaluation, and cardiac imaging. Results: Of 429 patients (age 16.3 ± 2.7 [range 8-21] yrs, 44% male) evaluated including 9 with pre-existing heart disease, 318 underwent echocardiograms and 23 also had cardiac MRI. Cardiac MRI was performed for abnormal screening ECG or echocardiogram or cardiovascular symptoms. New echocardiographic abnormalities were detected in 69 patients: 4 were possibly related to COVID-19 infection, 3 were new structural heart disease (2 anomalous coronary, 1 bicuspid aortic valve), and 62 were normal variants or trivial findings. New ventricular dysfunction (right or left, qualitative dysfunction or LV ejection fraction [EF] &lt;55%) was noted in 11 patients (LV EF mean 52.7 ± 2.6%, minimum 46%). Eight underwent cardiac MRI confirming trivial to no ventricular dysfunction and none of the 23 MRIs demonstrated late gadolinium enhancement or met Lake Louise criteria for myocarditis. All patients without new diagnoses of structural heart disease were ultimately deemed safe to return to previous levels of physical activity. Conclusions: Cardiovascular evaluation for RTP of youth after COVID-19 demonstrated mild transient abnormalities and incidental findings, but no diagnoses of myocarditis. These data suggest early concerns about subclinical myocarditis may have been overestimated. Future studies should consider the costs and benefits of current society algorithms for such evaluations.
Abstract 06: Feasibility Of Accelerated Code Team Activation With Code Button Triggered Smartphone Notifications
Authors: Cody Couperus, Zach Dezman, Rebekah Friedrich, Samuel Gurmu, Dan Lemkin, Nicholas Morris
Journal: Circulation (2022)

Introduction: In-hospital cardiac arrest mortality has improved only modestly in the past decade. Prior studies support the role of earlier defibrillation and epinephrine administration to improve outcomes. Timely code team activation facilitates expedient interventions and may provide an opportunity for quality improvement. We sought to accelerate the time to code team activation and increase the early distribution of patient-specific data to improve targeted treatments. Methods: We mapped code blue buttons present behind each patient bed to patient data through the Electronic Health Record. Use of the code blue button sent patient-specific data including admitting diagnosis, recent procedural history, presence of difficult airway, and most recent potassium, bicarbonate, troponin, and hemoglobin levels through a secure text messaging system to the code blue teams’ smartphones. Simultaneously, the code blue button contacted the hospital operator who activated the code blue team through traditional methods including overhead page and pager alerts. We piloted the system on four medicine inpatient units from November 2019 through May 2022. In our analysis, we evaluated the time from code blue button press to smartphone message receipt vs overhead page, time to epinephrine administration, and survival to hospital discharge. Results: There were 35 cardiac arrest events on the participating hospital units. The code blue button was the primary mode of code team activation for 12/35 (34.3%) of the events. The code team received smartphone notifications a median of 78 seconds (IQR = 47-127 seconds) before traditional notifications. The initial rhythm was non-shockable for 34/35 (97.1%) of the patients. The median time to documented epinephrine administration for codes activated with or without the code button was 2:57 and 4:00 (IQR = 0:34-6:07 vs. 2:07-4:30; p = 0.89). Survival to hospital discharge was 3/12 (25.0%) for codes activated with the code button and 4/23 (17.4%) when activated by other methods (p = 0.61). Conclusion: Implementation of a smartphone-based code button activated notification system reduced the time to code team activation by over one minute. Further evaluation in larger cohorts is necessary to assess the effect on patient outcomes.
Abstract 10541: Borderline Elevated Pulmonary Artery Pressures Not Meeting Criteria for Pulmonary Hypertension in Patients With Idiopathic Pulmonary Fibrosis is Associated With Lower Transplant-Free Survival
Authors: Badar Patel, Sirus J Jesudasen, Samuel Y Ash, Pietro Nardelli, Ruben San Jose Estepar, Eileen M Harder, Franck F Rahaghi, Aaron B Waxman, George Washko, Raul San Jose Estepar, Sydney B Montesi, Farbod N Rahaghi
Journal: Circulation (2022)

Introduction: Pulmonary hypertension (PH) in Idiopathic Pulmonary Fibrosis (IPF) is associated with poor outcomes. The hemodynamic definition of PH was revised from a mean pulmonary artery pressure (mPAP) ≥25 mmHg to &gt;20 mmHg. We sought to explore the implications of these criteria in patients with IPF with a focus on outcomes in those with an elevated mPAP not meeting criteria for Pre- or Post-capillary PH, herein termed Borderline PH. Methods: We identified patients with IPF who underwent chest CT, transthoracic echocardiography (TTE), and right heart catheterization (RHC) using the Mass General Brigham Research Patient Data Repository. Medical records were reviewed to confirm the diagnosis of IPF. Established hemodynamic criteria categorized patients by PH status. Patients with elevated mPAP &gt;20 mmHg not meeting the definition of Pre-capillary PH (PVR ≥3 Wood Units) or Post-capillary PH (PCWP ≥15 mmHg) were defined as Borderline PH. Categorical variables were assessed using Chi-squared, Continuous variables using Wilcoxon Rank-Sum, and transplant-free survival using Kaplan-Meier analysis and Gehan-Breslow-Wilcoxon test. Results: 212 patients were identified: PH Present (n=92), Borderline PH (n=45), and PH Absent (n=75). One year from RHC, transplant-free survival was lower in patients with PH Present (n=37/92, 40%; p = 0.0002) or Borderline PH (n=20/45, 45%; p = 0.009) compared to those without PH (n=49/75, 65%) (Figure 1). Additionally, patients with Borderline PH had lower Pulmonary Artery Pulsatility Index (3.6 (3.0-6.0) vs 6.5 (4.2-10.5); p &lt; 0.001), Pulmonary Artery Compliance (3.9 (3.2-4.6) vs 4.5 (3.4-5.8) mL/mmHg; p = 0.012), and an elevated Right Ventricular Stroke Work Index (9.9 (8.5-11.6) vs 7.3 (5.7-8.7) mmHg*mL/m 2 ; p &lt; 0.001) versus those without PH. Conclusions: In this retrospective study of patients with IPF, those with Borderline PH had lower rates of transplant-free survival and worse derived hemodynamics compared to those without PH.
Abstract 11006: Fick’s versus Cardiac MRI Measured Pulmonary Blood Flow in Pre-Fontan Assessment
Authors: Bhavikkumar Langanecha, Rajiv Chaturvedi, Mike Seed, Christopher Z Lam, Shi-Joon Yoo
Journal: Circulation (2022)

Background: Fick’s principle (FP) is unreliable if there are two sources of pulmonary blood flow (Q p ) with different saturations. We compared Q p and pulmonary vascular resistance (PVRI) measured by cardiac MRI (CMR) and FP in pre-Fontan patients. Material and Methods: Retrospective analysis of CMR and catheterization data obtained under the same general anesthetic from Jan 2009 to March 2021. FP derived Q p and PVRI used assumed O 2 consumption from Sackler’s equation. Paired T test was used for comparison between FP and CMR parameters. Results: 98 patients, with (mean ± sd): age 3.01±1.38 years and weight 13.31±2.4 kg. The FP derived Q p was 2.5(± 0.58) L/min/m 2 and PVRI1.91±0.61 Woods units*m 2 (WU*m 2 ). CMR measured pulmonary arterial flow (Q pa ) and pulmonary venous flow (Q pv ) were 1.97±0.55 L/min/m 2 and 3.49±0.76 L/min/m 2 , respectively. The PVRI using CMR Q pv was 1.38±0.47 WU*m 2 . The paired mean differences between Q p by FP and CMR Q pa or CMR Q pv were 0.53 (95%CI 0.41, 0.66; p&lt;0.001) and -0.98(95%CI -1.13, -0.83; p&lt;0.001), respectively. The paired mean difference between PVRI by FP and PVRI by CMR Qpv was 0.53(95%CI 0.44, 0.61; p&lt;0.001). The difference between CMR Q pv and FP derived Q p were correlated with aortopulmonary collateral flow (Pearson r=0.615, p&lt;0.001). PVRI derived from FP (1.91±0.61 WU*m 2 ) was higher than that from CMR (1.38±0.47, p&lt;0.001). However, this only resulted in one FP based PVRI estimate being &gt;4.0WU*m 2 when the CMR PVRI was &lt;4.0WU*m 2 . Conclusion: s: FP derived Q p is lower than CMR Q pv resulting in higher PVRI estimates by FP. In most patients this will not affect clinical risk stratification based on PVRI. In high-risk candidates for the Fontan, CMR based flow measurements are preferrable.
Abstract 10257: Diagnostic Yield of Screening and Associated Factors for Transthyretin Cardiac Amyloidosis in Severe Aortic Stenosis
Authors: Bryan Abadie, Adel Hajj Ali, Trejeeve M Martyn, Andres Carmona Rubio, Rishi Puri, Amar Krishnaswamy, James J Yun, Grant W Reed, Mazen A Hanna, Samir R Kapadia, Wael A Jaber
Journal: Circulation (2022)

Introduction: Transthyretin cardiac amyloidosis (ATTR-CA) has been associated with severe aortic stenosis (AS), with some studies finding up to 20% of patients who undergo transcatheter aortic replacement (TAVR) have ATTR-CA. New therapies for ATTR-CA have brought significant interest in identifying patients at high risk for this disease. The purpose of this study was to prospectively evaluate the yield of universal testing for ATTR-CA in older patients with severe AS. Methods: All patients ≥ 70 years with severe, native, and degenerative AS seen in valve clinic for evaluation of TAVR were referred for technetium-99m pyrophosphate cardiac scintigraphy (PYP scan). Diagnosis was made via a combination of planar grade, heart to contralateral lung ratio, and single positron emission computed tomography/computed tomography. Patients with a positive PYP scan were referred for appropriate laboratory testing to rule out AL amyloidosis. Clinical and echocardiographic factors were correlated with the PYP result. Results: Over a 12-month period, 787 patients with severe AS were screened of which 543 met the inclusion criteria. Of these patients, 298 underwent a PYP scan with 232 not undergoing the scan for logistical and scheduling issues during the pandemic. The positivity rate was 4.3% (13/298). Patients with a positive PYP scan had higher rates of carpal tunnel syndrome (54% vs 14%, p &lt;0.001), abnormal global longitudinal strain (&gt; -18%) (100% vs 69%, p=0.044), low stroke volume index (≤35 ml/m 2 ) (92% vs 42%, p&lt;0.001), thick intraventricular septum ≥ 1.1 cm (100% vs 79%, p=0.07), and abnormal left ventricular mass index (83% vs 46%, p=0.010). Conclusions: The prevalence of ATTR-CA in severe AS is lower than cited in previous studies, likely due to the expanded indication for TAVR. A multiparametric diagnostic algorithm or risk score for ATTR-CA in AS could enhance the yield of screening, reduce cost and unnecessary radiation, and result in more rapid treatment of amyloidosis.
Abstract 11009: A Novel Patient-Patient Network Medicine Approach to Refine Hypertrophic Cardiomyopathy Subgrouping: Implications for Risk Stratification
Authors: Ruisheng Wang, Ethan J Rowin, Barry J Maron, Martin S Maron, Bradley A Maron
Journal: Circulation (2022)

Introduction: In hypertrophic cardiomyopathy (HCM), the presence of left ventricular (LV) apical aneurysm warrants implantable cardioverter defibrillator (ICD) therapy consideration for primary prevention of sudden death (SD). However, a significant proportion of these patients may never experience an SD event. Thus, identifying parameters that modify SD risk in this population may be important clinically, but likely requires phenotyping methods that include robust patient-level information. Methods: Clinical, demographic and echocardiographic parameters were compiled for a large HCM referral population. Variables (N=52) were normalized to the cohort and the Pearson’s correlation was calculated between patients using r&gt;0.6 (after Benjamini-Hochberg correction), selected to maximize the patient:edge ratio. The SD event/risk profile was defined as: SD event/ ≥ 1 major HCM SD risk factor. Results: From N=3,412 HCM patients (male, 62%; 49 17 years at diagnosis) in the network, the clinical profile included maximum LV thickness, 18 4 mm; left atrial diameter, 41 7 mm; LV outflow tract gradient 30 mmHg, and N=68 (3%) patients with LV apical aneurysm. We identified N=17 distinct patient modules (range, N=19-483 patients/module). Module #15 was highly enriched for LV apical aneurysm (N=56/56); however, the SD event rate was significantly less compared to LV apical aneurysm patients in all other modules (N=12; 4% vs. 75%; P&lt;0.0001). Lower blood pressure and smaller left atrial size delineated LV apical aneurysm patient in module #15. Conclusions: This proof-of-concept patient-patient network analysis suggests that lower blood pressure and smaller left atrial size may contribute to a favorable SD risk profile among HCM LV apical aneurysm patients.
Abstract 10451: Efficacy and Safety of Ebronucimab, a Monoclonal Antibody Against Pcsk9, in Patients With Hyperlipidemia: Result From a Phase 2, Randomized, Double-Blind, Placebo-Controlled Study
Authors: Wang Zhen, Zhaohui Pei, Jiyan Chen, Guogang Zhang, Dongye Li, Yu Xia, Baiyong Li, Max Wang, Xiang Ni, Guoqin Wang, Junbo Ge
Journal: Circulation (2022)

Introduction Elevated low-density lipoprotein cholesterol (LDL-C) is a well-recognized risk factor for cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to Low-density lipoprotein receptors (LDL-R) and triggers their degradation. Inhibiting PCSK9 activity results in lowering LDL-C levels and further reduceing the risk of cardiovascular events. Ebronucimab (AK102) is a novel fully human immunoglobulin G1 (IgG1) monoclonal antibody against PCSK9. Objectives To evaluate the safety, efficacy of ebronucimab and further identify the optimal dosing scheme in patients with hyperlipidemia. Methods A total of 260 Chinese patients with hyperlipidemia (≧18 years, male or female) were planned to be enrolled, and randomized to receive ebronucimab 450 mg every 4 weeks (q4w), 300 mg q4w, 150 mg q2w, 75 mg q2w or matching placebo via subcutaneous injection. The patients were treated up to 12 weeks (day 85). Serum samples were collected at preselected timepoints to analyze the lipid profiles. Results Efficacy Ebronucimab showed significant and dose-dependent LDL-C reductions from baseline. At week 12, the mean reductions in LDL-C were 65.48 %, 48.14%, 63.69% and 37.39% for 450 mg q4w, 300 mg q4w, 150 mg q2w and 75 mg q2w dose groups, respectively. Patients in the 450 mg q4w and 150 mg q2w groups achieved higher and more sustained LDL-C reduction compared with other dose groups. Similar trend was observed in serum levels of total cholesterol (TC), apolipoprotein B (ApoB), lipoprotien (a) (LP[a]). Safety A total of 49.6% (130/262) patients experienced at least 1 treatment-emergent adverse event (TEAE), 109 patients (109/210 [51.9%]) in ebronucimab groups and 21 patients (21/52 [40.4%]) in the placebo group. Most TEAEs were mild and moderate. No adverse events were apparently dose dependent with ebronucimab. The overall incidence of serious adverse events (SAEs) was 3.4 % (9/262). Conclusions Ebronucimab was generally safe and well tolerated in Chinese patients with hyperlipidemia. Patients treated with ebronucimab achieved a significant reduction in serum levels of LDL-C and other lipids, especially in 450 mg q4w and 150 mg q2w treatment groups.